to more active doses, guarded each day by the dose of the day
before, till he has manufactured within himself enough antitoxin
to make him proof against any outbreak of the disease. (See
Hydrophobia.)
8. Cholera.—The specific organism of Asiatic cholera, the “comma-bacillus,” was discovered by Koch in 1883; but such a multitude of difficulties arose over it that it was not universally recognized as the real cause of the disease before 1892, the year of the epidemic at Hamburg. The discovery of preventive inoculation was the work of many men, but especially of Haffkine, one of Pasteur's pupils. Ferran's earlier inoculations in Spain (l885) were a failure. Haffkine's first inoculations were made in 1893. At Agra, in April 1893, he vaccinated over 900 persons; and from Agra went to many other cities of India. Altogether, in twenty-eight months (April 1893-July 1895) no less than 42,179 persons were vaccinated (many of them twice) in towns, cantonments, gaols, tea estates, villages, schools, &c., “without having to record a single instance of mishap or accident of any kind produced by our vaccines” (See Cholera.)
9. Bubonic Plague.—The Bacillus pestis was discovered in 1894 by Kitasato and Yersin, working independently. The preventive treatment was worked out by Haffkine in 1896: “Twenty healthy rabbits were put in cages. Ten of them were inoculated with Haffkines plague vaccine. Then both the vaccinated rabbits and the other ten rabbits that had not been vaccinated were infected with plague. The unprotected rabbits all died of the disease and in their bodies innumerable quantities of the microbes were found But the vaccinated rabbits remained in good health. Professor Haffkine then vaccinated himself and his friends. This produced some fever, from which, after a day or two, they recovered. Plague broke out in Byculla Gaol, in Bombay, in January 1897. About half the prisoners volunteered to be inoculated. Of these developed plague on the day of inoculation, and it is probable that they had already plague before the treatment was carried out. Of the remaining 148 who were inoculated, only 2 were afterwards attacked with plague, and both of them recovered. At the same time, of the 173 who had not been vaccinated, 12 were attacked and out of these 6 died.” (See Plague.)
10. Typhoid Fever.—The Bacillus typhosus, was discovered by Klebs, Eberth and Koch in 1880-81. The first protective inoculations in England were made at Netley Hospital in 1896 by Sir Almroth Wright and Surgeon-Major Semple: 16 medical men and 2 others offered themselves as subjects. The first use of the vaccine during an actual outbreak of typhoid was in October 1897 at the Kent County Asylum: “All the medical staff and a number of attendants accepted the offer. Not one of those vaccinated—84 in number—contracted typhoid fever; while of those unvaccinated, and living under similar conditions, 16 were attacked This is a significant fact, though it should in fairness be stated that the water was boiled after a certain date, and other precautions were taken, so that the vaccination cannot be said to be altogether responsible for the immunity. Still, the figures are striking” (Lancet, March 1898). In 1899 Wright vaccinated against typhoid more than 3000 of the Indian army, at Bangalore, Rawal Pindi and Lucknow. Government has now sanctioned voluntary inoculation against typhoid, at the public expense, among the British troops. All regiments leaving for the tropics are offered this inoculation and each year a larger percentage of the soldiers are accepting it. Here are some of the statistics: In August and September 1905, 150 men of a single regiment were inoculated: of these, 23 refused to accept a second inoculation. The regiment reached India September 28. A month later, typhoid fever broke out; and during the following few months 63 cases were observed in the regiment. With but two exceptions, the disease attacked only the men who had not been inoculated, and both of these exceptions were men who had refused a second inoculation. Careful experiments were made with the second battalion of Royal Fusiliers in India in 1905 and 1906. The average strength of this regiment was 948 men. During the two years, 284 were inoculated with Wright's anti-typhoid vaccine. The regiment had a total of 46 cases of typhoid. Thirty-five of these were men who had not been inoculated; 9 had been inoculated. Five of the uninoculated died; none of the inoculated died. Another Indian regiment the 17th Lancers, in 1905, 1906 and 1907 inoculated about one-third of its men. During the three years it had 293 cases of typhoid fever. There were 44 deaths, with not a single death of an inoculated man. During the first half of 1908, in the largest seven Indian stations where careful records were kept, out of a total of 10,420 soldiers, 2207 volunteered for inoculation. Typhoid developed in 2% of the uninoculated, and in less than 1% of the inoculated men. Forty-five deaths occurred. Five per cent of these deaths were among the uninoculated and 1% was among the inoculated men. … In the United States army, a medical board has strongly recommended anti-typhoid vaccinations, and vaccination is now offered to those who desire it. Already 2000 soldiers have voluntarily received inoculation. The German army has adopted the same means of prophylaxis, and is pushing it vigorously” (Warbasse, loc. cit.).
Beside the preventive treatment, bacteriology has given us “Widal's reaction” for the early diagnosis of the disease—a matter of the very highest practical importance. A drop of blood, from the finger of a patient suspected to be suffering from typhoid fever, is diluted fifty or more times, that the perfect delicacy of the test may be ensured; a drop of this dilution is mixed with a nutrient fluid containing living bacilli of typhoid, and a drop of this mixture is observed under the microscope. The motility of the bacilli is instantaneously or very quickly arrested, and in a few minutes the bacilli begin to aggregate together into clumps. This “clumping” is also made visible to the naked eye by the subsidence of the agglutinated bacilli to the bottom of the containing vessel. The amazing delicacy of “Widal's test” is but a part of the wonder. Long after recovery, a fiftieth part of a drop of the blood will still cause clumping: it has even been obtained from an infant whose mother had typhoid shortly before the child was born. A drop of blood from a case suspected to be typhoid can now be sent by post to be tested a hundred miles away, and the answer telegraphed back.
11. Malta Fever (Mediterranean fever).— The Micrococcus Melitensis was discovered in 1887 by Sir David Bruce. The work of discovering and preparing an immunizing scrum was done at Netley Hospital. In this fever, as in typhoid and some others, Widal's test is of great value: “The diagnosis of Malta fever from typhoid is, of course, a highly important practical matter. It is exceedingly difficult in the early stages” (Manson). Even in a dilution of 1 in 1000, the blood of Malta fever can give the typical reaction with the Micrococcus Melitensis; and this occurred in a case at Netley of accidental inoculation with Malta fever: one of three cases that have happened there. The case is reported in the British Medical Journal October 16, 1897: “It appears that he had scratched his hand with a hypodermic needle on September 17, when immunizing a horse for the preparation of serum-protective against Malta fever, and his blood, when examined, had a typical reaction with the micrococcus of Malta fever in 1000-fold dilution. The horse which has been immunized for Malta fever for the last eight months, was immediately bled, and we are informed that the patient has now had two injections, each of 30 cub. cm. of the serum. He is doing well, and it is hoped that the attack has been cut short.” About 50 cases of the fever, by April 1899, had been treated at Netley. The Lancet, April 15, 1899, says that the treatment was “with marked benefit: whereas they found that all drug treatment failed the antitoxin treatment had been generally successful.” Happily, it has now been proved that the usual source of infection with Malta fever is the drinking of the milk of infected goats: thus, by the avoidance, or by the careful and thorough boiling of the milk the fever may be prevented: and prevention is better than cure. In 1904 a commission was sent out to Malta by the Royal Society at the request of our government, to discover how the fever is conveyed to man. They found that it is not conveyed by air, or by drinking-water, or by pollution of sewage, or by contact; nor are its germs carried, like those of malaria, yellow fever and sleeping sickness, by insects. They found that it might be conveyed in food. Therefore Bruce examined the milch-goats, since goats' milk is universally drunk in Malta. The goats looked healthy enough, but it was found that the blood of 50% of them gave the Widal reaction, and that some 10% of them were actively poisonous: monkeys fed on milk from one of them, even for one day, almost invariably got the disease. On the 1st of July 1906, an official order was issued forbidding the supply of goats' milk to our garrison. The year before, there had been 643 cases among our soldiers alone. In 1906 up to the 1st of July there were 123 cases. During the rest of the year, including the three worst months for the fever, there were 40 cases. In 1907 there were 11 cases; in 1908 there were 5 cases, in 1909 there was 1 case; in 1910, by latest accounts, none.
12. Epidemic Meningitis.—The history of the serum treatment of epidemic meningitis affords an admirable example of the place of experiments on animals in the advancement of medical practice This form of meningitis is one of the worst ways in which a man can die. Dr Robb, who had charge of the Belfast fever hospitals during an epidemic in Belfast, calls it “the most terrible in its manifestations, and the most disastrous in its death-rate of all the epidemic diseases met with in English-speaking countries.” Very little is known as to the way in which it spreads, and the public health authorities cannot prevent its sudden appearance in a town. “Many of those attacked,” says Dr Robb, “died within a few hours of the onset, and that after terrible suffering; while many of those who survived the acute attack lingered on for weeks and months, going steadily downhill in spite of every effort to save them. Again, many of those who did survive were left permanently maimed.” That is the usual picture of the disease when it is left to the older methods of treatment.
By means of inoculation experiments, Dr Flexner and Dr Jobling, of the Rockefeller Institute, proved that the disease is due to a particular kind of germ, diplococcus intracellularis. They obtained these germs from the bodies of patients who had died of the disease; they cultivated the germs all by themselves, in test tubes, apart from all other kinds of germs; and they were able to reproduce the disease in monkeys by injecting under the skin a minute quantity of this pure culture of the germs. It may be worth noting
